Provider Demographics
NPI:1831522267
Name:GRIFFIN, JACKLYN MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:MICHELLE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44344 DEQUINDRE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1040
Mailing Address - Country:US
Mailing Address - Phone:586-323-1500
Mailing Address - Fax:586-323-1515
Practice Address - Street 1:44344 DEQUINDRE RD STE 260
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1040
Practice Address - Country:US
Practice Address - Phone:586-420-1117
Practice Address - Fax:586-323-1515
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249109363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner